More to the point, when I used to pay my doctors directly, they didn't
overcharge - they cwertainly didn't starve <LOL!>, but they couldn't get
away with overcharging, because then, people would just go to a differnt
doctor.
The whole HOMo nonsense caused a price inflation.
ALso, there is a difference between having helath insurance, and being
forced to go through this halfasses HMO crap system that they invented
during, what was it, the Nixon years? Doctors are manipulated into over-
charging by the HMO system. Now, it's called "health insurance", but
what it actually is, is a series of gigantic HMOs.
We used to pay the physician directly, and the insurance was there for
"the big stuff". As above, it helped keep costs down. Now, everyone is
forced into this bureaucratic nightmare - rather than paying th
ephysician, we have to pay the bureaucracy, which then pays the
physician, so the doc almost *has* to overcharge just to get what s/he
*should* get. It's lunacy.

Yup. As far as I know, the AMA has nothing to do with it, unless what
he's going on about is specialist training - and that's just common
sense; you don't want a family practice doc, or an orthopedist, doing
brain surgery - you want someone who has trained, and continues to train,
in the methodologies of brain surgery.

Well, it's also dang hard to cope with more than one or maybe two
specialties - there isjust so much knowledge... But malpractice
insurance *is8 a killer. What it is, is that the good physicians are
forced to pay for the few bad apples, plus those people who do consider
lawsuits a form of retirement plan, and *everyone* suffers because of it.

Exactly. THe determiner is the HNMO/"Insurance" groups. THey decide
what is considered a "fair and customary" price, I think that's the term.
But ifthe Doc charges you that price, they don't get it all from the HMO
- they get a percentage. So they charge more, so that they get the fiar
price doled out to them by the HMO.
ALso, salary is one thing, the cost of doing business is another. In
some places, obstetritians have become an extict species because they
have to pay out *more* (in insurance, and business costs) than they earn.

The worst is socialized medicine. I lived in Canada for 10 years, and
between the waiting times to see specialists, the fact that you couldn't
get any testing that wasn't approved (meaning, common and average, IOW,
if you had an unusual condition, you were prob out of luck), and so on -
well, if there is one thing that makes me shudder, it's the talk of
socializing the US system. I'd prefer to see vouchers given to low-
income folks...

To be honest, what I think the biggest problem is, is lack of attention
to detail. A lot of the jobs associated with medical careare
fundamentally about keeping focus on the mundane detail-oriented tasks -
in the pharmacy, much of this is related to reading and keeping records,
reading labels, double-checking whether the medicines are the correct
ones. Oh yeah, and counting units of medicines (pills, vials, whatever).
Same is true in pharmaceutical manufacturing - increasingly, people
resist taking correction, or even following protocols, because they see
their jobs as a matter of their own personal egos, as opposed to what the
jobs actually are (a matter of human helath). If they don't want to do
the job, they ought to get out of the field. ((No, I don't have paper
references - I get much of this stuff first-hand from people who work in
teh biomedical and/or phamaceutical fields.))

I disagree about worker skill - success has to be a blend of *both*.
After all, a worker has to have enough skill to work in accordance with
protocols/methods, and thosear epart and parcel of business practices.
If part of the business calls for the sterilization of a 10,000 gallon
fermenting tank, and all plumbing etc. associated with it, between every
product run, you have to have workers who both understand *why* this
needs to be done, and how to do it. Also, the quality control
department's protocols are useless if people are incapable of
comprehending and carrying-out those protocols.
What it is, is that people have to know how to do what they're supposed
to/need to, and they also have to give enough of a damn about what
they're doing (and why) so that they'll do it correctly.
Why do you think, for example, there are so many recalls of meat
recently? The manufacturing protocols are well-known - what's lacking is
worker skill and/or worker attitude (i.e., whether they give a damn about
making sure they follow the protocols).

Why would a neurosurgeon allow the nurse to write a prescription? That's
simply not a good practice. But your point was mainly that:

Again, when it comes to the fields of medicine and pharmaceutical
development and manufacturing, there is no mystery as to what are the
best principles and protocols. THe main pitfall is corner-
cutting/carelessness. SOmeone is spending more time on the job thinking
about going out to the bar with freinds that evening, rather than
concentrating on the job (and, subsequently, the possible harm that their
laziness/carelessness can cause to others).

Sometimes, tho', I think that it's the insurance that leads to a greater
acceptance of carelessness, at least in some cases. IOW, if someone ucks
fup, the thought is, "Well, at least the insurance would cover it".
IMO, the *root* of the problem (in all fields) is that epople spend more
time thinking about how to avoid taking responsibility for their foul-
ups, than they spend trying to be carefult to not foul-up in the first
place. The cuirrent notion seems to be taht saying "Oops, I'm sorry"
somehow fixes things like malpractice, vehicular manslaughter, rape, and
pretty much everything else. All that regret does is possibly indicate
whetehr the person is likely to repeat the action (that is, assuming the
perp isn't faking it, whcih really is not a difficult thing to do).
Ultimately, the solution is for people to think less about childish
egotism, and more about taking pruide in doing their jobs well - and, for
that matter, pride in living responsibly. In recent years,
"responsibility" has become a dirty word - people are **FAR** happier
being told "suck my a**" than they are with being told "take some
responsibility for your actions".

Insurance is a problem unto itself - part of the mess has to do with
peole not reading contracts (and getting independent advice regarding the
parts they don't understand), an dpart of it is the company not keepign
to its contracts, or else making contracts deliberately vague in some
areas.
But a fundamental problem, which also realtes to insurance, is that it
sued to be considered wise to keep enough in savings and investments to
pay off at least *most* of one's debt in case of an emergency. Nowadays,
it seems that if you do so (as opposed to conspicuously wallowing in a
seemngly-endless cacaphony of material posessions), most people consider
you to be a freak, a psycho, or some just plain dangerous =8-O
It also seems to me that the increased reliance (usually due to being
forced into fthat reliance by governemntal policies established, IIRC,
during the Nixon administration) upon insurors/HMOs has played a hug
epart, and IMO the largest part, in creating the current combination of
inflated costs and inflated insurance rates - and concommitant decreasing
coverage, because those inflated costs are exceeding even the insurance
companies' ability to keep up with them.
I never paid my doctor with a chicken (I'm not THAT old!! <LOL!>) but I
do remember the days of "cash up front". And, even though $20 back then
took much longer to earn than does $20 today (due to the deflated value
of the dollar), the fact is that we did manage - and my family was by no
means well-off. THe otehr fact is that family physicians were more
willin gto let a patient either pay by installments, or even, on some
occasions, provide service to the children of people who had fallen on
particularly hard times and accept payment whenever the people could pay.
Yeas, I know full well that medicine is more advanced now (I worked in
medically-related fields for several years, so I'm not a total ignoramous
about the subject), but the problem is not only with advanced diagnostics
- it's with a system that encouraces overcharging and has inflationary
practices pretty much built into it.

Most people either cannot or will not learn from history or past wisdom,
but what pops into my "Jurassic" mind is Aesop's fable about the
grasshopper and th eants. What it is, is that there are currently *far*
more grasshoppers than there are ants, and when Winter comes, trouble
will follow.
It might be that enough people are trying to figure things outm, and a
disaster might be avoided, but it's just as likely that the
"grasshoppers" will learn to organize, not to do anything constructive,
but rather, to pillage the ant colonies.
THere is a science-fiction book titled "The Postman" - there was a bad
movie adaptation fo it with Kevin Kostner as the lead, but go back to the
original book. It deals with the same sort of opposing forces
(constructive action versus destructive action).

Pretty cool. How high are the runs near you- top to bottom? More than 800ft?
Parents of kids, whether in private or public schools, have to be involved
in their kid's education, and be advocates for their kids. A well known
private school near here has been known to have a history of abuse in it.
Just because you're spending $30K/annum doesn't mean you don't have to check
in once in a while.
http://www.google.com/search?q=%22upper+canada+college%22+sex+abuse+teacher
I know guys who went there, and they all said it was widely known what was
going on, and they are all now big supporters of diverse, co-educational,
public schools. (Like me. I went to a rival private school back then for a
very short time, and would never put my kid through a private school
environment either.)
A few years ago we moved our kid out of a plainly mediocre school led by a
plainly mediocre principal to a great one led by a great one. This happens
all the time despite the 'official version' of things they tell you at the
board of education. (This second *principal* doubled as the school's hockey
coach...7 a.m. practices...how cool is that? I've never known an
administrator to volunteer like that.)
We are still dealing with the shadow cast by the poor teaching she got at
the other place. People tell us we're crazy when the find out how she's
doing, but we have high expectations to suit her abilities.

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